Healthcare Provider Details

I. General information

NPI: 1487264677
Provider Name (Legal Business Name): MAJID YAVARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

313 N CEDAR ST APT 113
LANSING MI
48912-1288
US

V. Phone/Fax

Practice location:
  • Phone: 954-842-6025
  • Fax:
Mailing address:
  • Phone: 954-842-6025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351046646
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: